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4 Cancer research is understood!
from July 4th to 7th, 2019, the BEST of CSCO (BOC) and Best of Asco 2019 China (BOA) were grandly held in Xi'an, ancient capital. After 10 years of development, in addition to the unprecedented scale of this session, the content of the BOC has also been incorporated for the first time, indicating that local research is increasingly going to the front desk and made a voice belonging to China to the world. In the morning of July 6th, Professor Hu Yi, and , PLA General Hospital (301 Hospital), introduced , of Peking University People's Hospital , respectively. Professor Fan Yun from Zhejiang Cancer Hospital made a wonderful review of the above studies. The summary of this article is as follows:
small cell lung cancer 's second -line therapy
recurrence has always been a major problem that plagues small cell lung cancer (SCLC) treatment. Recently, a multi -center basket -type phase II clinical study showed that the ORR of LurbineCtedIn single drugs for recurrent small cell lung cancer has improved, reaching the main end of the research. LurbineCtedin is an inhibitor of RNA polymerase Ⅱ. In theory, it has a good inhibitory effect on small cell lung cancer relying on high -speed transcriptional process. The results of
research showed that the objective relief rate (ORR) treated with LurbineCtedin was 35.2%, reaching the main research end. At the end of the secondary study, the mid -level relief duration (MDOR) was 5.3 months, and the median without progress (MPFS) was 3.9 months, and the median total survival (MOS) was 9.3 months. Essence
In terms of adverse reactions (AE), the incidence of AE in level 3 is 34.3%, of which the incidence of granulocytes of 3-4 degrees is 22.9%, and the incidence of 3-4 degrees anemia is 6.7%. It is not difficult to find that
is compared with previous clinical research results with the previous SCLC second -line therapy. The ORR of LurbineCTEDIN is far more than other SCLC second -line therapy drugs, including: topology for Kang, ammonia Jane, Nawuli Yutab, etc., and even more rare is that it is even more rare that it is. What is even more rare is that The improvement of ORR was eventually transformed into an extension of OS, showing obvious advantages. In terms of adverse reactions in
, compared with the standard second-line chemotherapy drugs-topology for Kang, LurbineCTEDIN's 3-4 adverse reactions have a significant decrease in the incidence of adverse reactions, suggesting that it has good treatment safety.
Based on the above excellent efficacy and safety data, the US Food and Drug Administration (FDA) awarded LurbineCTEDIN "orphan drugs" in August 2018. Further evaluate LurbineCTEDIN combined with gemycin as a second -line treatment and safety of patients with small cell lung cancer patients, III Study (NCT02566993) is currently underway, and the results are worth looking forward to. lung cancer immunotherapy (IO) biomarker exploration
is carried out in full swing with immunotherapy research, a focus topic is increasingly prominent: how to screen the advantages of PD-1 inhibitors before treatment? As of now, PD-L1 is still the most recognized and most widely used sign, but there are still many shortcomings in clinical applications. The clinical studies initiated by Professor Wang Jie and foreign researchers in
, respectively, showed that compared with patients with hypertrophic tumor mutation load (BTMB), high BTMB patients can obtain longer PFS and OS for PD-1 inhibitors treatment for PD-1 inhibitors. Improve, suggest the efficiency prediction of BTMB on PD-1 inhibitors; further cross-analysis of BTMB and PD-L1, and find that there is a certain complementarity for the prediction of efficacy.
Based on this, mystic research explores the predictive effect of the efficacy of non-small cell lung carcinoma that uses BTMB and PD-L1 to test IO immunotherapy. Studies have shown that BTMB is a promising Biomarker. Especially when BTMB and PD-L1 are combined to detect, it can avoid invalid applications of IO. At the same time, it also develops new research fields in CTLA4 and PD-L1 monoclonal anti-resistance.
Of course, this study brings us more enlightenment and questions, such as: how consistent is bTMB with tissue tumor mutation burden (t-TMB), how to choose the detection panel and platform, and what is the optimal Cut-off value? Determining whether it can currently be used clinically will depend on further research to give us answers.
Research progress of EGFR-TKI in adjuvant treatment of NSCLC
The efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) in patients with advanced non-small cell lung cancer (NSCLC) with EGFR-sensitizing mutations has been widely studied. Clinical studies and real-world data confirm that, however, its status in postoperative adjuvant treatment of NSCLC has always been confusing, and therefore it has always been a hot topic of attention and research.
After the results of the ADJUVANT study led by Chinese scholars were reported in 2017, it aroused widespread interest and controversy in the industry. The EVAN study is a clinical study led by Chinese scholars. As the first multi-center, randomized, phase II clinical study to compare the efficacy and safety of adjuvant treatment of erlotinib and NP regimen in stage IIIA NSCLC patients with EGFR mutations, The study basically repeated the results of the ADJUVANT study: compared with chemotherapy, erlotinib showed better efficacy and significantly improved the 2-year disease-free survival (DFS) rate (81.35% vs. 44.62%, P0.001) and DFS (HR 0.268, 95%CI 0.136-0.531, P0.001), and the safety is better. The current OS data is not yet mature, but the erlotinib group has shown improved trend. Based on this, experts recommend that erlotinib should be considered as a treatment option for patients with R0-resected stage IIIA NSCLC with EGFR mutations.
It should be pointed out that there are still many debates about adjuvant TKI in NSCLC, such as: 1) about the time of adjuvant TKI treatment and OS benefit issues; 2) research shows that the use of EGFR-TKI will increase ALDH stem cell-like through the NOTCH pathway. The number of lung cancer cells, and activation of the NOTCH pathway can also induce drug resistance, progression and metastasis of lung cancer cells. These changes will undoubtedly have an adverse impact on the treatment of lung cancer and the prognosis of lung cancer patients.
In fact, experts from the International Association for the Study of Lung Cancer (IASLC) and the FDA issued a consensus in 2018 that DFS or event-free survival (EFS) can be used as an endpoint for adjuvant treatment of NSCLC. Based on the results of the above studies, refer to ima Tinib in Gastrointestinal stromal tumor and dapafenib and trametinib in the adjuvant treatment of renal cancer. The 2019 CSCO lung cancer guidelines have cautiously listed EGFR-TKI as operable stage IIIA or IIIB NSCLC. Class II recommendation for post-adjuvant therapy.
Third-line treatment of NSCLC (ALTER 0303 study)
In the field of third-line treatment of NSCLC, there has been a lack of large-scale, phase III, randomized controlled studies, and a few retrospective or small-sample studies have not shown that chemotherapy or targeted therapy can bring significant benefits. , because there is no high-level evidence, third-line treatment lacks standards. The
ALTER 0303 study came into being under this clinical dilemma. The study results showed that compared with placebo, anlotinib prolonged OS by 3.33 months (P0.05), reaching the primary research endpoint; subgroup analysis also showed that it can bring clinical benefits to both adenocarcinoma and non-adenocarcinoma. Benefit; even for patients with T790M mutation, anlotinib can significantly prolong OS; as an anti-angiogenic drug, the overall incidence of adverse reactions of anlotinib is not high, and most of them can be adjusted through drug dosage adjustment and corresponding symptomatic treatment. control. Therefore, in the 2019 CSCO lung cancer guidelines, anlotinib was listed as a recommended drug for standard third-line treatment of NSCLC.
html In July, it was midsummer, and the sun was blazing, just like the enthusiasm of the participants for learning, and the vigorous development of clinical oncology research and practice in my country.This article was first published: Medical Tumor Channel
Author of this article: Jia Gang Henan Provincial People's Hospital
Responsible editor: Sharon
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